Tag Archives: medication

LB attacked a staff member at dinner time tonight. Unexpectedly. For no apparent reason. After some careful but excessive sauce action (tomato and brown) on his plate. This lead to restraint, more restraint and medication. The situation was explained to me carefully in detail when I turned up an hour or so later.

“Er, can you claim for your shirt?” I asked his key nurse, inanely, after my other questions were answered (but left unanswered because there aren’t answers).

There are also no words really to make any sense of this, without falling back on jargon and social care speak.

I saw LB briefly after the debrief (and ripped shirt). He was in his room. I was armed with an alarm. He didn’t say much, just muttered really. I rang later that evening to see how he was, and the support worker (love her) went upstairs to check on him.

“LB, your mum’s on the phone. She just wants to know that you’re ok.”
“Yes.”
“Can I get you a drink or anything?”
“Yes.”
“What would you like?”
“Blackcurrant.”

Sleepless night, worrying about the end of Section 2. Then a last minute meeting at the unit this morning with LB’s head teacher, teacher, Vicki (a Charlie’s Angel), and unit team members to discuss his return to school. Bit of a rocky start to school return yesterday. He was taken to the primary site (as far as we can tell) and refused to get out of the car. “I’m confused”, he said.

Team LB Ed were impressive throughout the meeting. I was bemused by the vigorous writing down of the descriptions they provided of LB’s decline into “CRISIS” (beginning to seriously hate this term) when I’d already told so many professionals about this, but hey ho. Engagement at any level is engagement. It was also a reminder of how dire things had got.

The gap between education and health was palpable but also manageable with flexibility and a shared concern for LB. Plans were made for him to be supported to return to Trax and the farm with unit staff accompanying him. Sensible, informed engagement. Good. The ending of Section 2 was discussed. This would be discharged (?) today with an anticipation that he would agree to stay as an informal patient. If he wanted to come home, the mental capacity team would be called in. A further section unlikely because he’s currently a chill pill.

‘Er, can we be told whether he’s an informal patient or issued (?) with a DoLS (deprivation of liberty safeguard)?’ Oh yes. Action point; keep parents informed. No words.

The meeting finished with a new Team LB Ed/Health (Yowsers) and a general love-in about how much better LB had become over the last month. It was genuinely heartwarming and sealed with a cheeky smile from LB when we left. “Tsk”, I said to head teacher, as she had a weep outside the unit, “The crying days are over, we’re moving on to better places”.

Later that afternoon I got a call from the unit. LB wanted to know if I was going to visit tomorrow. “Eh???? Really??? Yes of course I will. I can come now if he wants?” I hadn’t arranged to visit this afternoon because I saw him before and after the meeting this morning. After a quick check I was told, yes, LB wanted me to visit today.

Five minutes later I was driving in the sunshine, humming to the radio, loving stupidly the fact that LB was actually asking to see me.

As soon as I saw him I kind of recognised but ignored the signs. I gave him the photos of the forensic police investigating Rosie’s break-in. “YOU LIAR!!!“, he shouted, raging. And, instantly, we were back to four weeks ago.

I don’t know what’s happened since I left him there, around 6pm. I rang later and was told he was still very, very agitated. I read into that; possible restraint? Medication? Harm to staff? Almost definitely no Trax tomorrow if medicated? A Section 3???? I don’t know.

And LB in deep, deep distress.

Now, I don’t know, they don’t know and maybe (as often is the case) we’ll never know, why he got so distressed so suddenly. I’m sure it’s to do with the fact they had to inform him of his rights and the ‘discharge’? of the section. It’s the only thing that’s changed between this morning’s chill bear dude and this afternoon. I don’t know what was said to him about this discharge from section? (Is it a set statement that’s read out, or a more measured interpretation that he might understand?) I think he thought he was coming home when I turned up tonight. What else could account for him asking if I was going to visit, and his immediate distress when I did.

He can’t possibly understand the complexities of the Mental Capacity Act or the Mental Health Act (as is the case for a lot of people including me). To expose him to either in a “thinking” capacity is cruel and unnecessary. Especially as he doesn’t really have a choice about staying or leaving. The system is seriously flawed.

We went to visit this evening, a bit concerned as LB had been sleeping all afternoon. He’d been sleeping yesterday when Rosie and I visited and was sluggish for a bit while we were there. A change in medication was agreed at yesterday’s weekly team meeting. Concern tentacles appearing a go-go.

He was in bed but woke up like a chill pill when we pitched up. Rich gave him photos off the Fagan and Whalley website (a new competitor on the heavy haulage company front) and we hung out, chewing the fat about Dappy’s recent altercation in a Hereford nightspot, Maggie T’s death and adding photos of Chunky Stan looking out the window on a holiday to Devon, to the growing gallery on his wall. We had a chuckle.

When it was time to leave, LB took us downstairs to see us out. No staff were around but there were tasty cooking smells.

“You’d better find someone to let us out,” we said.
“SECURITY!” called LB cheerfully wandering off down the corridor. He reappeared alone.
“Ha, looks like we’ll have to stay the night. That’ll be a laugh.”
“No no no!” said LB, with a sudden determination. “J! J! Where are you J!!?”

Yesterday, I raged enough at the emergency social care guy to get the duty psychiatrist to call me. This is the learning disability team psychiatrist. We had an astonishing exchange that went on for nearly 20 minutes. He kept insisting that, if anything happened this weekend, we had to call the out of hours GP who would give us a prescription for LB. He would email the other psych, who had discharged him, and tell her what had happened for Monday. I tried to explain that when LB goes off on one, he goes off on one and there ain’t really a convenient space to call the GP, collect a prescription and find a nearby chemist. He didn’t get it. LB ain’t his patient. He ain’t seen him. He can’t do anything else.

Blimey, that don’t matter. Dr Crapshite only saw him once before discharging him so no big relationship there.

No dice. He just kept repeating the out of duty GP path. It could almost have been a recorded message.

I don’t get how he can be a specialist in learning disability and have no understanding of what I was describing. I also don’t understand what the point of a duty psychiatrist is if they ‘can’t’ do anything. Stupid, meaningless layers of process that just mean ultimately, nothing happens. Eventually he asked me if LB had got worse recently. “HE PUNCHED HIS TEACHER IN THE FACE THIS MORNING!” I exploded. “Oh, has he not done that before?” I hung up.

The phone rang straightaway. He’d leave a prescription for lorazepam at our surgery.

LB had an appointment with the GP after school today. He’d had a liver function test to check out the medication for his newly diagnosed epilepsy. The doc said that there was a bit of a problem because the blood level showed that the drug was at a level that suggested it wasn’t being effective. Instead of a level (of something but no idea what) of between 40-80, LB’s blood showed 25.

The options were to up the dose to a level at which it was effective, continue the dose (but it wouldn’t be achieving anything) or stop the dose because, as it wasn’t working and he hadn’t had a seizure for three months, he didn’t need it. It was up to me to decide.

Whoa. Hit me with the first example of non paternalistic decision making I’ve ever experienced when the stakes are so high, why don’t you?! The potential of tonic clonic seizures or even stronger medication with hideous long term side effects.

I got the doc to talk me through it all again, and once it became clear that upping the medication was only really treating the medication, as opposed to preventing seizures, I decided to keep the dose as it is until we met with the neurologist again. I’m a bit suspicious of stats at the best time and didn’t really buy the 25/40-80 stuff. So the outcome of my first patient weighted decision making; defer the decision.

So home, kettle on, dig out school diary to find out the latest happenings in the sixth form.

“LB has been brilliant today. He has an egg to look after as part of our work on trust and bring back tomorrow hopefully in one piece”.

“Wow! An egg of trust? LB! Where’s your egg matey?”

“In the bin.”

“What? Whaddaya mean???”

“It’s in the bin, mum.”

And it was. Crushed. Barely retrievable.

“Why did you chuck the egg away, LB?”

“Cos I’m ANGRY WITH THE SCHOOL. They wouldn’t let me do what I wanted to do”, he fumed.

“Yeah, well sometimes you have to do what you’re told, matey”, I said, putting on a pan of water to boil a new egg of trust. “And sometimes you wish you were told what to do…”